Bradley R. Straatsma MD, JDBradley R. Straatsma MD, JDJules Stein Eye InstituteJules Stein Eye Institute

The Challenge of Diabetic The Challenge of Diabetic RetinopathyRetinopathy

Diabetes and Diabetic Retinopathy

• Worldwide health problems• China. 92.4 million diabetics • Saudi Arabia. Diabetes affecting 13.6% of

population

Yang et al. 2010 World Health Organization, 2011

Diabetes and Diabetic Retinopathy

• United States- 23.5 million diabetics- 40% of diabetics have retinopathy- Diabetes is the leading cause of new

blindness in adults 20 – 74 years of age

Hazin et al. 2010

Randomized Clinical Trials

• Control of glycemia (A1c ≤ 7.2%), serum lipids and blood pressure prevent onset and retard progression of retinopathy

• Treatment of proliferative retinopathy and macular edema decrease vision loss

Hazen et al. 2011

ICO Response

• Collaborate with WHO and ophthalmology societies

• Advocate for National Health Plans that provide adequate care for diabetes and diabetic retinopathy

ICO Response• Support population-based programs that

detect and treat diabetic retinopathy regardless of patient ability to pay

• Admirable programs at Aravind, Peking University and

other institutions

Peking University

ICO Response

• Encourage use of Internet and personalized medicine to improve care of diabetes and retinopathy

• Recognize transformative technology of data processing, data storage and wireless communication

Transformative Technology

• Data processing. iPhone has computer processing power > 1970s IBM Mainframe

• Data storage. Internet is migrating to the “cloud” with thousands of data storage units

• Wireless revolution. Enables a billion people to communicate in real time

Mills and Ottino, 2012

Transformative Technology

• Costs have decreased and Internet access is global

• Sub-Saharan Africa population with mobile phone subscriptions

2012 – 42%2020 – 70%

Euromonitor International, 2012

SightBook™

• Free application on iPhone, iPad and Mac computer

• Provides a secure Internet channel of communication and data for a diabetic patient and designated physicians

SightBook™

• Patient- Sends visual acuity test results - Receives Hbg A1c, serum lipids and

blood pressure reports- Receives fundus photographs - Receives treatment

recommendations

SightBook™

• Diabetes Physician - Sends Hbg A1c, serum lipids and blood

pressure reports - Sends treatment recommendations

• Ophthalmologist- Sends fundus photos and

interpretation- Sends recommendations

Personalized Medicine

• SightBook™ and similar Internet applications are suitable for a limited but growing number of patients

• Personalized medicine increases communication and patient motivation to improve management of diabetes and retinopathy

Summary – ICO Response

• Collaborate to form National Health Plans for diabetes and retinopathy

• Support population-based programs to detect and treat diabetic retinopathy

• Encourage Internet programs and personalized medicine to improve management of diabetes and retinopathy